Outcomes for Newborns with Mild Hypoxic-Ischemic Encephalopathy: A Retrospective Study

Background: HIE remains a significant cause of mortality and long-term disability in late preterm and term newborns. At birth, the only available distinction between mild, moderate, and severe HIE is based on the clinical ground. Nevertheless, mild HIE can be presented with subtle or subjective clinical features which may mislead the treating physician and delay his decision to intervene. Methods: This is a retrospective descriptive study examined all inborn newborns ≥ 35 weeks gestational age born at a single, tertiary level Neonatal Intensive Care Unit (NICU) in women’s hospital. The study revised newborns who were admitted to NICU during the period from November 2014 till November 2020 under the diagnoses of mild HIE. The decision to start therapeutic hypothermia in cases of mHIE was off-label and it was taken according to the clinical judgment of the treating team. Results: Out of the 265 newborns admitted with a history suggestive of HIE or neurological deficits, only 116 newborns matched the diagnosis of mHIE according to the above-mentioned exclusions. 19 newborns out of the 116 mHIE cases received therapeutic hypothermia. Antepartum and or intrapartum complications were recorded in 48 mothers including an infant of insulin-dependent diabetic mother 12, pre-eclampsia 3, cord prolapse 2, shoulder dystocia 2, antepartum hemorrhage 8, chorioamnionitis 6, poor CTG tracing 13, and ruptured uterus 2. Mean gestation was 38±2 weeks, mean birth weight was 3.0±0.5 kg, Cesarean section was 57 % in the un-cooled group vs 75% in the cooled group. Mean Apgar score at 10th minute was 7.9±1.8 vs 5.3±2.2 in the un-cooled vs cooled group, the p-value is 0.002. Arterial cord pH was 7.15±0.3 vs 6.92±0.26. The base deficit in the first-hour blood gas was -7.83±5 vs -12± 5.6 (P=0.005). The Total number of cooled newborns was 19 (16%). Respiratory support was required in 76% of un-cooled newborns vs 95 % of cooled newborns. Most of the newborns have achieved full sucking power within 10 days (99%). Cooled newborns had to stay longer in the NICU because of the added number of cooling where the length of stay was 11±4.7 days vs 6.9±4.7 days in un-cooled newborns. The MRI brain was done on 25 newborns, 12 MRIs were reported as abnormal (48 %) and consistent with hypoxic-ischemic changes, 5/97 in the un-cooled cases and 7 in the cooled cases. Neurodevelopmental assessments at 12 months and 18 months of age were abnormal in 14/116 newborns (12%). Conclusion: The current assumptions about the benignity of mild form of HIE may not be accurate. More attention to this category of HIE, clear diagnostic criteria, longer clinical observation, and vigilant neurological assessment are all required.

Management of Shock in the Pediatric Emergency Unit of the National Teaching Hospital HKM (CNHU-HKM) in Cotonou

Introduction: The mortality of severely ill children presenting with life-threatening emergencies remains high in emerging countries. The objective of this study was to evaluate the management of shock in the pediatric emergency department of the CNHU in accordance with WHO guidelines. Methods: The cross-sectional study covered the period from 1 November 2019 to 31 October 2020. All records of children aged 1 month to 18 years, who presented with shock, were analysed after implementation of life-saving measures. Results: The hospital incidence of shock was 2.6%, and its diagnosis was made on admission in 81.2% of cases. The median age of the children was 29.50 months. Septic shock occurred in 50% of cases. Mortality was 50%, related to the presence of fever on admission. The triage and sequence of management was correct. However, the median time to care was 30 minutes, the use of the intraosseous access was non-existent, and traceability should be improved. Conclusion: The introduction of an intraosseous kit is essential in order to reduce management delays. The priority remains the fight against infectious pathologies.

COVID-19 in Children at the National Teaching Hospital of Cotonou: Epidemiology, Clinic, and Therapy

Objective: The description of COVID-19 in children has evolved over time. We report here its epidemiological, clinical and evolutionary aspects in a hospital setting in sub-Saharan Africa. Methods: The study was prospective cross sectional, from January 1 to June 30, 2021. It included all children from 1 month to 18 years of age, admitted to the pediatric emergency ward of the CNHU HKM of Cotonou, tested positive for SARS-CoV-2 by RT-PCR on nasopharyngeal swabs. At admission, screening of children was targeted, based on symptoms common in children with COVID-19 according to the literature. Results: A total of 93 children were screened during the period, among which 18 were positive for SARS-CoV-2. The hospital frequency was 2% (18/895). The median age was 11 months. The most common symptoms were fever, cough, and shortness of breath. Half of the children had comorbidities, including heart disease, sickle cell disease, and nephrotic syndrome. The moderate form was the most frequent with pneumonia (10/18). The severe form was present in 2 children. Malaria was associated in 2 cases. The evolution was favorable in 17 children, after a mean hospitalization time of 5.81±2.74 days. One 4-month-old infant, with suspected multisystem inflammatory syndrome (MIS-C) died. Conclusion: The evolution of COVID-19 in children is benign, but severe forms are possible. A systematic screening should be proposed to all febrile children admitted to the emergency room.